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Introduction
As I write my 11th annual Chief’s Report to the Orthopaedic
Journal at the Harvard Medical School, the financial world
seems to be crumbling around us. After a hard-fought political
season, we have chosen our 44th President of the United
States and have experienced a major transition in our House
of Representatives and Senate. Who would have thought that
this new administration of “hope and change” would have been
beset with such enormous challenges as the financial sector
deteriorated? Fortunately, the medical field has been relatively
immune to tremendous variations in the United States
economy. We await President Obama’s plans on Healthcare
Insurance reform and are all monitoring our practices in hope
that we will be able to deliver the same high quality patient
centric, safe and effective care that we have grown accustomed
to providing to our patients.
IN MEMORIAM
In December we were saddened by the passing of Robert D.
Leffert, MD. Dr. Leffert retired from practice in 2000. He was a
Professor of Orthopaedic Surgery at Harvard Medical School and
the former Chief of the Department of Rehabilitation Medicine
and Chief of the Surgical Upper Extremity Rehabilitation Unit at
the MGH. He was keenly interested in neuromuscular disease,
biomechanics and kinesiology. He was national recognized for
his work in the areas of brachial plexus injuries and thoracic
outlet syndrome. Over the years Dr. Leffert served on many
committees at the MGH, HMS, and the American Academy of
Orthopaedic Surgeons. Dr. Leffert was a skilled clinician and
educator; he was a valued friend and colleague to many here in
the Department and the MGH. He will be sorely missed.
Condolences to the Leffert family: his wife, Linda; children,
Adam and Lisa; and Grandsons, Samuel and Eli.
FACILITIES
The Yawkey Center for Outpatient Care continues to be the
shining star of our out patient programs at the MGH. At present
we have occupied every last office and exam room of the
second and third floor of the Yawkey Center and we have begun
to look at our ambulatory centers in the North (North Shore
Center for Outpatient Care), MG West, and MG South (Brigham
and Women’s/Mass General Health Care Center at Foxborough)
as sites for growth. In addition, the Sports Medicine Center
continues to be the focus of intense activity and innovation in
the field.
The Orthopaedic Ambulatory Surgery Center
The Orthopaedic Ambulatory Surgery Center (ASC) at MGH West
has been one of the jewels in the crown of the Orthopaedic
Department. The Orthopaedic ASC is under the direction of
Jeffrey Wilson, MD, Medical Director and Claire O’Brien, RN,
MBA, CNORN, Nursing Director. This state-of-the-art facility is
now being fully utilized. Dr. Wilson reports, "In January 2009,
the 7,000th case was performed. We have performed close to
3,500 nerve blocks and approximately 50% of all patients having
surgery at the ASC have a nerve block. Our block success rate
for postoperative analgesia is 98.7%. We have met all our goals
every quarter and patients continue to rate their experience
as excellent!" New Foot and Ankle surgeon, Anne Johnson,
MD, began utilizing the ASC in December and became the 19th
staff surgeon. A new pilot program started last year to have
Anesthesia Residents rotate through at the ASC has been a tremendous
success and will continue this year. Congratulations
to the team!
Brigham and Women’s / Mass General Health Care Center at
Foxborough
The Brigham and Women’s / Mass General Health Care
Center at Patriot’s Place, a 1.3 million square foot development
adjacent to Gillett Stadium, is open! This massive complex
includes shopping, restaurants, entertainment, commercial
properties as well as a state-of-the-art Health Care Center
directly in front of the main gate of Gillett stadium. This center
includes physician offices, four operating rooms for outpatient
surgery, advanced diagnostic imaging, and is the cornerstone
of the BWH Ambulatory Center in the South. The Department
of the Orthopaedic Surgery at the MGH along with members of
the BWH Faculty are staffing this unit to provide outstanding
care for our patients in the South. Medical Director, Thomas
Gill, MD, and Associate Medical Director, Andreas H. Gomoll,
MD, are providing the leadership for the development of the
Orthopaedic Program at this new facility. Orthopaedic Surgery
Physicians working with Drs. Gill and Gomoll are Peter Asnis,
MD; Eric Berkson, MD; Philip Blazar, MD; Christopher Bono,
MD; Christopher Chiodo, MD; Wolfgang Fitz, MD; Scott Martin,
MD; Chai Mudgal, MD; Joseph Schwab, MD; and George
Theodore, MD... to name a few.
On February 9, 2009, physicians from the area were able
to meet and greet at the new facility and review the short and
long-term vision of the facility as presented by Drs. Peter Slavin
and Gary Goettlieb at the official ribbon cutting ceremony. The
Grand Opening of the facility was held to a standing-room only
crowd. Physicians, administration, as well as members of the
Kraft family, who own the New England Patriots, were on hand
for the opening of the facility.
We look forward to the opportunity to care for patients in
the South in this new state-of-the-art facility and the prospect
for growth in the Department. We thank all of those who were
involved in the planning of this facility especially David Gaynor,
Ann Prestipino and James Zachazewski.
North Shore Center for Outpatient Care
The North Shore Center for Outpatient Care construction
is being finalized and we will be hosting a Grand Opening in
August of this year. This Center located on Endicott Street in
Danvers is just off of Rt. 128 and will include both a medical
office building and an ambulatory surgical care center. This
building conceived and constructed as a joint effort by the
North Shore Medical Center and the MGH is a 125,000 square
foot outpatient care facility and an 80,000 square foot medical
office building. This site will be the newest addition to the
Orthopaedic Department and will offer us the opportunity to
partner with North Shore colleagues to develop an important
North Shore / MGH Orthopaedic Center of Excellence. Dr.
Brian Grottkau will be the Medical Director of the Orthopaedic
Program in this facility. Dr. Doug Halsedt from the North Shore
Physician’s Group has been intimately involved in the planning
of the medical office space. Orthopaedic Services that will be
initially included are Pediatric Orthopaedics, Hand and Upper
Extremity, Orthopaedic Spine, Orthopaedic Oncology and Foot
and Ankle. In addition, we are looking for other services to
move to the North.
Sports Medicine Center Celebrates Third Year!
In October of this year, the Sports Medicine Center will
celebrate its third anniversary. The Center is located at 175
Cambridge Street and is situated on the 4th floor of the South
Building. The Center houses all of the services and facilities
that are necessary to both diagnose, treat, and to help patients
with sports related injuries recover in one modern facility.
Building of the 3rd Century
The new Building of the 3rd Century (B3C) is taking shape.
It will occupy the site of the former Clinics Building and its
scheduled opening in 2011 coincides with the 200th anniversary
of the MGH. This nearly half a million square foot facility
will house Radiation Oncology, Radiology, In-Patient and Out-
Patient Surgery, and twelve new operating rooms including
increased Intensive Care In-Patient Unit capacity. In addition,
the top five floors will house increased bed capacity for Cancer,
Neurology and Neurosurgery. Mr. Sumner Redstone, Executive
Chairman of the Board of Directors of Viacom, has pledged
over $40 million to develop the new Emergency Department
which will be relocated on the White Lobby Level of the new
facility. We anxiously await the arrival of this new facility and
the expanded capacity it will give us as a result of the new
Orthopaedic Operating Rooms.
Liberty Hotel
The Liberty Hotel is open and packed. Heralded as Boston’s
best luxury hotel, this beautiful establishment is adjacent to our
Yawkey Building and maintains the design and layout of the
original architecture of the former Charles Street Jail. We are so
fortunate to have this fabulous facility so close with its two wonderful
restaurants, The Clink and Scampo, and meeting space.
We have used the Liberty Hotel for patient families, visiting
professors, meetings and other events. It has been spectacular!
FACULTY UPDATES
Joseph Schwab, MD, has had an impressive second year.
Dr. Schwab continues to divide his time between clinical activities
on the Orthopaedic Spine and Oncology Services and in
basic science research in the areas of bone and soft-tissue
tumors. His current interest is in molecular pathophysiology
of human chordomas and he has made some important
progress in his work. In addition, we congratulate Dr. Schwab
and his wife, Christina Ferrone, MD, a physician in the MGH
Department of General Surgery, for the new addition to their
family, baby son, Peter.
It was a pleasure to have welcomed,
Gleeson Rebello, MD, to the Department
and as the newest member of the
Pediatric Orthopaedic Service last year.
In 2004, Dr. Rebello completed the prestigious
Peabody Research Fellowship
with the Pediatric Orthopaedic Service.
His areas of expertise include pediatric
trauma, pediatric and adolescent hip,
neuromuscular disorders and foot and
ankle pathology. Dr. Rebello will be
working to expand the expertise of the service and all the service’s
teaching activities. We wish Dr. Rebello continued success
in the Department.
It is a great pleasure to welcome,
Anne Holly Johnson, MD, to
the Department and to the Foot and
Ankle Service. Dr. Johnson, attended
the University of Chicago Pritzker
School of Medicine, and completed both
her Orthopedic Residency and a Foot
And Ankle Fellowship at the Hospital
for Special Surgery in New York. Dr.
Johnson has a keen interest in teaching.
Her clinical interests include:
sports injuries to the foot and ankle, trauma and post-traumatic
arthritis and deformity, Achilles tendon problems, and forefoot
deformity. Dr. Johnson will split her time between the Yawkey
Center for Outpatient Care and the North Shore Center for
Outpatient Care. We welcome Dr. Johnson, her husband Kurt,
and their three lovely children Sam (4), Will (3), and Cat (1) to
the MGH Orthopaedic community.
It is a pleasure to welcome Eric
Berkson, MD, to the Department of
Orthopaedic Surgery at the MGH. Dr.
Berkson will be joining Drs. Gill, Zarins,
Asnis,Theodore and the other members
of the Sports Medicine Orthopaedic team
as its newest member. Dr. Berkson will
be primarily based at the BWH/MGH
Health Care center at Patriot Place in
Foxborough. Dr. Berkson received his
BA Summa Cum Laude from Brandeis
University in 1994 and received an MA in Computer Science
from Brandeis University in 1995. He graduated from the
University of Chicago Pritzker School of Medicine with an
MD with Honors in June 2000. He completed an orthopaedic
residency at Rush University Medical Center in Chicago and a
Sports Medicine fellowship at Massachusetts General Hospital
in 2006.
Dr. Berkson specializes in advanced arthroscopic and
reconstructive procedures of the shoulder, knee and elbow, and
has an interest in cartilage restoration. His current research
interests include pitching injuries and studies of shoulder
and elbow biomechanics. He will be leading development of a
Sports Performance Center at our facilities in Foxborough.
Outside of medicine, Dr. Berkson and his wife Stephanie
enjoy hiking and spending time with their son Jadon and dog
Femur. Dr. Berkson and his wife are expecting a baby in June.
We wish him the best in his new role in the Department.
Another new addition to
Department and to the Sport Medicine
Service is Luke Oh, MD. Dr. Oh graduated
from Georgetown University School
of Medicine and did his Orthopaedic
Residency at the Hospital for Special
Surgery in New York. Dr. Oh completed
three fellowships, the Sports Medicine
Fellowship here at the Massachusetts
General Hospital, an Elbow Surgery
Fellowship at the Mayo Clinic and additional
Sports Elbow Training with James Andrews, MD. Dr. Oh’s
clinical interests include: Sports Medicine, Shoulder and Elbow
Injuries of the Throwing Athlete and Rheumatoid Elbows. His
specific area of expertise is in Elbow Arthroscopy, Arthroplasty,
and Reconstructive Surgery. His research interests include biomechanics
of the shoulder, elbow and knee. Dr. Oh will be an
active member of the Sports Medicine and Shoulder Services and
will bring his expertise in the area of sports medicine, shoulder
and hand and upper extremity including elbow reconstruction.
In 2009, Dr. Oh along Thomas Gill, MD, and Guoan Li, PhD,
received the O’Donoghue Research Award from the American
Orthopaedic Society for Sports Medicine. We welcome, Dr. Oh,
his wife, Donna and their daughters, Giuliana (2 years old) and
baby Isabella.
I am also pleased to welcome Hany
S. Bedair, MD, to the Department and
to the Adult Reconstructive Surgery
Service (Arthroplasty). Dr. Bedair
graduated from Yale University School
of Medicine. He did his Residency at
the University of Pittsburgh Medical
Center and completed an Orthopaedic
Adult Reconstruction Fellowship from
Rush University Medical Center in
Chicago, Il. Dr. Bedair will work both
at MGH and NWH where he will be joining Dr. Joseph McCarthy
at the Kaplan Center for Joint Reconstruction. Dr. Bedair’s
clinical interests are in the area of adult reconstructive surgery
of the hip and knee (total hip, total knee arthroplasty, partial
knee arthroplasty), including complex primary and revision
surgery. His research interests focus on periprosthetic infections,
arthrofibrosis, and clinical outcomes. Dr. Bedair, and his
wife, Naglaa, enjoy hiking, mountain biking and snowboarding.
We welcome the Bedair’s to MGH!
SERVICE UPDATES
Adult Reconst ructive Surgery Service (Arthroplasty)
The Arthroplasty Service under the direction of Service
Chief and Department Vice Chair, Andrew Freiberg, MD, continues
to grow and prosper not only on the main campus but
also at the Newton Wellesley Hospital (NWH) facility as well.
Once again the Arthroplasty Service had an outstanding presence
at this year’s Orthopaedic Research Society, The Knee
Society, and the American Association of Orthopaedic Surgeons
Annual Meetings in Las Vegas, NV with 17 podium presentations,
posters, and exhibits. Our clinical practices continue to
grow and there are two new additions this year including more
procedures being performed at NWH and also the recruitment
of Dr. Hany Bedair from Rush Presbyterian Hospital in Chicago.
Dr. Bedair will work both at MGH and NWH joining Dr. Joseph
McCarthy at the Kaplan Center for Joint Reconstruction.
All of us on the Arthroplasty Service have worked hard with
various initiatives to improve per-operative efficiency, safety,
and opportunity for improved volume.
We are delighted to have recruited
Kristen Wood, NP who has joined the
Service full time to work with patients
pre-operatively and coordinate their
in-house and post-operative care. This
has been a much needed and fantastic
addition!
This year we successfully hired a
full time assistant for our Registry data
collection in the Yawkey Outpatient
Center. This has been an important
and critical addition that now allows us to collect preoperative
and postoperative outcomes and satisfaction scores from all of
our patients.
Close collaboration continues with the members of the
Arthroplasty Service and the Bioengineering Laboratory under
the direction of Guoan Li, PhD. Dr. Li reports, “We continue to
work on a better understanding of gender differences in kinematics
and biology of the knee.” Our Fellows continue to work
with Dr. Li and his outstanding graduate students and report
great successes in their research experience.
Members of our Service hosted an OR-Live broadcast on
the scientific and clinical information about Vitamin E Infused
Polyethylene (E-Poly). His broadcast seminar was viewed from
people all over the world and brings the newest information
about total joint replacement bearing surfaces to the forefront.
This year marks the 49th Fellowship class including Drs.
Sanaz Hariri, Ian Panuncialman, Fabian vonKnock, and Nina
Shervin. Dr. Hariri was awarded the first Health Care Policy
Fellowship by AAHKS and will be off to Stanford University for
further training and research. Dr. Panuncialman is staying in
the Boston area while his wife finishes her medical training. Dr.
vonKnoch has accepted a prestigious position at the Schulteis
Clinic in Zurich where he will specialize in joint replacement
and trauma surgery. Dr. Shervin is actively exploring job opportunities.
Best wishes Fellows!
Podiatry Service
The MGH Podiatry Service staff provides ambulatory foot
care, out-patient surgery, orthotic services, and non-invasive
lower extremity arterial testing (PADNet) at the Main Campus
(YCOC 3). Other practice sites include: three MGH-affiliated
health centers (Revere, Chelsea & Charlestown), South End
Community Health Center and Lynn Community Health
Center. Our staff members also cover in-patient consultations
at the MGH and SRH. Assisted by our residents, each staff
member volunteers his/her services at the Pine Street Inn Foot
Clinic, as a longstanding affiliation with Boston HealthCare for
the Homeless. We maintain a valuable clinical relationship with
the MGH Orthopaedic Foot & Ankle Service, often collaborating
in patient care.
The MGH Podiatry residency program has one of the most
extensive & comprehensive curricula in the country, including
over twenty non-Podiatry medical and surgical month-long
block rotations, broad & diverse longitudinal training experiences
in clinical podiatry and foot & ankle surgery, and extensive
didactic activities including weekly lectures via a Podiatry
post-graduate education website. Our residents receive training
in foot & ankle surgery from over 25 faculty members – podiatric,
orthopaedic and plastic surgeons. An additional area
hospital and a free-standing surgicenter recently joined the
program as new training sites, which now total seven venues,
including the MGH and the MGH Orthopaedic ASC. Very soon,
we hope to reactivate the clerkship program, open to 4th year
podiatric medical students nationwide, helping to attract the
best & brightest residency applicants.
The Sixth Annual MGH Podiatry Service Winter Lecture,
‘The iShoe Insole: research & development, current design and
clinical applications for patients with disequilibrium in stance
& gait’ (guest speaker: Katharine Forth, PhD- researcher from
Harvard, MIT, University of Houston and NASA) was held in
January 2009, drawing almost 50 attendees including podiatrists,
physical therapists, orthotists, and other medical professionals
from MGH and other metropolitan Boston hospitals.
"The clinicians and faculty members of our Service strive
to provide excellence in patient care, as well as in post-graduate
education. Expanding our clinical practice to locations within
existing and new Partners facilities, north, south and west of
Boston has now become both a necessity and priority for us.
Adding a ‘research arm’ to our Service is yet another objective
we hope to achieve in the near future." notes Dr. Scardina.
Hand and Upper Extremity Service
The Hand and Upper Extremity Service continues to
expand both in clinical volume, teaching programs, and clinical
and basic research.
Geographically, we are major utilizers of the MGH Waltham
Ambulatory Surgical Unit as well as seeing new and follow-up
patients at MGH West. We will soon have a physical presence in
the new Foxboro facility and in the near future, in the Danvers
outpatient center.
With the merger with the MGH Plastic Service this past
year we have had 4 clinical fellows along with cross rotations
with the 3 Brigham and Women’s Hand Fellows. We continue to
have PhD candidates doing research as well as numerous international
visitors. This past year saw the start of a collaborative
rotation with the shoulder service with one fellow spending an
additional 6 months with the Hand Service. Leadership of the
Fellowship has been transferred from Dr. Sang-Gil Lee to Dr.
Chaitanyal Mudgal.
The Hand and Upper Extremity Service produced 15 peer
review publications, 13 analytic reviews and book chapters
and two textbooks over the past year! We are featured in local,
regional, national, and international symposium with roles
varying from speakers to moderators to course chairmen.
Shoulder Service
The Harvard Shoulder Service, a partnership between the
Massachusetts General Hospital (MGH) and the Brigham and
Women’s Hospital (BWH) is under the direction of Jon J.P.
Warner, MD. Dr. Laurence D. Higgins, Director of the Sports
and Shoulder Service (BWH) acts as the Fellowship Director for
the Shoulder Service. Dr. Thomas Holovacs is a valuable part of
the Shoulder Service at MGH and contributes to Resident and
Fellowship education.
This year the Harvard Shoulder Service is training five
Shoulder Fellows and two international visitors. One Fellow
has already accepted a position as an Upper Extremity Surgeon
at Boston University. One Fellow has plans to return to the
University of Tel Aviv in Israel as an Upper Extremity Surgeon.
The other three Fellows are in the process of finalizing their
future career plans.
The Clinical growth at the MGH has continued at a rapid
pace. The emphasis of our service remains the highest quality
care for all problems of the shoulder; however, our principal
focus is to act as an outlet for complex and revision problems
which are referred not only from the New England Region but
from around the United States and the International community.
Academic highlights have included presentations at
National and International Meetings with many publications.
This year the New England Shoulder and Elbow Society
held it’s fifth annual meeting in January at Jay Peak, Vt. and
over 140 people attended our banquet. Dr. Warner is the
President of this Society this year.
Orthopaedic Oncology Service
The Orthopaedic Oncology Service under the direction of
Service Chief, Francis Hornicek, MD, PhD, is one of the largest
in the world. Members of the Orthopaedic Oncology Service
have been the pioneers in the area of transplantation in limb
sparing procedures in musculoskeletal oncology.
The Orthopaedic Oncology, Medical Oncology, Radiation
Oncology Services and the members of Pathology and Radiology
from the Center of Sarcoma and Connective Tissue Oncology,
part of the MGH Cancer Center, provide comprehensive care for
patients with bone and soft tissue tumors which are benign and
malignant in children and adults. They are a regional, national
and international referral center for these complex tumors. Dr.
Dempsey Springfield recently joined the service and has added
enormous depth to the areas of Resident and Fellow Education,
as well as the treatment of complex intra-pelvic sarcomas. Dr.
Kevin Raskin, Dr. Dempsey Springfield, Dr. Joseph Schwab
and Dr. Hornicek continue to divide their clinical service with
additional passions including orthopaedic research and medical
student and resident education. Dr. Hornicek and Zhenfeng
Duan, MD, PhD, run the Molecular Sarcoma Laboratory and
have multiple collaborative efforts to study tumor agenesis and
stem-cell research on tumor pathogenesis.
The Musculoskeletal Tumor Fellowship, one of the most
sought after in the country, brings together members of Beth
Israel Deaconess, The Children’s Hospital and the MGH to develop
a truly world-class Fellowship program. The Orthopaedic
Oncology group has a truly impressive past, a highly productive
present and a future that includes innovation in many areas!
Pediatric Orthopaedic Service
The Pediatric Orthopedic Service at the Massachusetts
General Hospital added an additional outstanding young
pediatric orthopedic surgeon to its ranks during this past year.
Gleeson Rebello, MD, joined us in practice. He hopes to focus
on afflictions of the pediatric, adolescent and young adult hip.
Additionally, he will be manning our new Foxboro site once the
facility receives its DPH certification.
We are also pleased to continue our research program
within the Laboratory for Tissue Engineering. Yunfeng Lin,
DMD, PhD, has joined us as a post-doctoral follow within our
lab. Research is moving along at a brisk pace. We are working
on many interesting topics involving adipose derived stem cells
with the ultimate goal of developing novel therapeutic applications
for pediatric orthopedic and spine afflictions.
Sports Medicine Service
The Service continues to grow both in terms of staff and of
programs. Several programs will expand into the new space in
the MGH/BWH Medical Center at Patriot Place in Foxborough.
This facility will provide the setting for new programs and for
expansion of several of our current activities. One of our former
fellows, Eric Berkson, MD, joined the MGOA in February
and will be based primarily there. Kelly McInnis DO, who
recently joined the Sports Medicine Service, will also spend
some of her time in Foxborough where she will develop our
activities in non-operative sports medicine, the female athlete,
and concussion management in collaboration with Spaulding
Rehabilitation Hospital.
We have recruited another one of our former fellows, Luke
Oh, MD, to join the Service when he finishes his Elbow fellowship
at the Mayo Clinic. He will be based in both Foxborough
and at the MGH Sports Medicine Center in Boston, where he
will develop a program in elbow surgery with a strong interest
in the injuries sustained in sports.
In a major initiative to optimize the care of our patients,
Laurence Ronan, MD of the Internal Medicine Associates will
establish a Primary Care Sports Medicine Practice in the Sports
Medicine Center and continues as Team Internist for Boston
Red Sox. He has also been active in a number of collaborative
activities within the MGH/SRH complex and with some national
agencies.
The Service is developing two major clinical programs: the
MGH Sports Concussion Center in collaboration with Dr. Ross
Zafonte, the Chairman of Physical Medicine and Rehabilitation
and Director of the Spaulding Rehabilitation Hospital. A necessary
concomitant of these clinical activities is a flexible and comprehensive
database to store and retrieve clinical data. The need
is being actively pursued under the leadership of Dr. Berkson.
Our basic science research remains very productive in
collaboration with Guoan Li, Ph.D and his colleagues in the
Biomechanical Engineering Laboratory. This past year, Dr.
Thomas Gill and Dr. Li received the O’Donoghue Sports Injury
Research Award from the AOSSM for excellence in clinical
research and human in-vivo studies. In addition, we have furthered
our collaborative research programs with MIT and the
Department of Physical Anthropology at Harvard College. In
collaboration with Joseph Paradiso, Ph.D and his group at MIT,
we have a major initiative in the biomechanics of throwing
using an innovative high speed video system, as well as exciting
new technology with Inertial Motion Unit monitoring devices.
In a related study, we are collaborating with Daniel Lieberman,
PhD and his group at Harvard College to study the evolution
of throwing in primates. A number of fellows, residents and
students are involved in all of these research activities.
Thomas J. Gill, MD, Chief of the Sports Medicine Service
and Director of the Sports Medicine Center in the Department
of Orthopaedic Surgery continues as the Medical Director of
the Boston Red Sox, Head Team Physician of the New England
Patriots and Team Physician of the Boston Bruins. In collaboration
with William Palmer, MD of the Department of
Radiology, he initiated a CME course in Sports Medicine which
was very well-received with over 200 participants this past year,
and is expanding in 2009 to include symposia on rehabilitation.
He was also nominated by the Dept of Medicine for its annual
Resident Teaching Award.
Bertram Zarins, MD, the Augustus Thorndike Clinical
Professor of Orthopaedic Surgery, continues his clinical practice
and his activities as the Head Team Physician for the
New England Revolution and as a Team Physician for the
New England Patriots and Boston Bruins. He has substantial
responsibilities for the clinical education of the residents and
fellows, and developed a comprehensive educational curriculum
that will be on our website and available to all members of
the Harvard Program this year.
Peter Asnis, MD has developed a busy clinical practice
including a new program in hip arthroscopic surgery which has
grown rapidly. He was named the Head Team Physician for the
Boston Bruins in 2008, and continues as a Team Physician for
the Boston Red Sox and the New England Patriots.
George Theodore, MD remains heavily involved in the
MGH Sports Medicine Fellowship Program, and continues
his activities as a Team Physician for the Boston Red Sox and
Consultant to the New England Patriots.
Arthur Boland, MD is now focusing primarily on the
educational activities of residents, students and fellows on
our Service, in addition to his office practice. He continues to
contribute heavily to the sports medical aspects of the Harvard
University Health Service. In addition, the Sports Medicine
Service staff covers the athletic activities of several local colleges
and high schools.
Thomas J. Gill III, MD is involved with all aspects of
our research program as Director of Research for the Sports
Medicine Service.
Orthopaedic Spine Center
The Orthopaedic Spine Center at the MGH is under the
skillful direction of Kirkham B. Wood, MD, and now in its 10th
year of existence. All aspects of spine care, teaching, and research
are under the auspices of this service. Our Multidisciplinary
Orthopaedic Spine Center includes: Attendings, Kirkham
Wood, MD; Joseph Schwab, MD; and Physiatrists: James Sarni,
MD; Leonid Shinchuk, MD; and David Binder, MD. In addition,
James Rathmell, MD, an anesthesiologist with the MGH Pain
Center works closely with this multidisciplinary program to
provide a full breadth of services to our patients.
Dr. Joseph Schwab, the newest member of this division, is
a member of two services, the Orthopaedic Oncology Service
and the Orthopaedic Spine Center. Dr. Schwab’s work and interest
is in metastatic disease of the spine, primary spine tumors,
and bone and soft-tissue tumors. Dr. Schwab is integrating a
highly active clinical practice along with his clinical practice in
Orthopaedic Oncology.
The Harvard Combined Spine Fellowship (BWH attendings,
Drs. Mitchell Harris and Christopher Bono) has three
fellows (2 at MGH, and 1 at BWH). The fellows are actively
involved in teaching and research programs in addition to their
clinical duties.
Dr. Kirk Wood and Dr. Guoan Li, Director of the
Bioengineering, continue to collaborate actively in the area
of Spine Kinematics. Dr. Wood is using the Dual-Fluoroscopic
Kinematics system to better study the kinematics of the cervical
and lumbar spine. Dr. Li explains, “The implication of
this work is to better provide excellent kinematics’ data as we
move into the field of disc replacement surgery.” In addition,
Dr. Wood has developed a spinal database along with Henrik
Malchau, MD, PhD.
RESEARCH UPDATES
Bioengineering Laboratory
The Bioengineering Laboratory, under the direction of
Guoan Li, PhD, continues its tradition of innovation in the
area of joint engineering and biomechanics. This year they
began reporting in-vivo data using the dual fluoroscopic imaging
system for the accurate measurement of in-vivo dynamic
joint kinematics. This cutting-edge technique along with the
validation from the robot testing system has moved the joint
kinematics analysis to a whole new level of accuracy and significance,
and is providing new concepts in Total Knee and
Shoulder Arthroplasty, cartilage contact biomechanics in sports
injuries, and intervertebral disc deformation in adult spines.
Peter Asnis, MD, and Michal Kozanek, MD, of the
Bioengineering Laboratory, in collaboration with Bryan Kelly,
MD from the Hospital of Special Surgery, have recently completed
a cadaveric study which described the cross sectional
anatomy of the iliopsoas tendon and its relationship to the
acetabular labrum. The results were presented at the 54th
annual meeting of the Orthopaedic Research Society and will
be published in the August issue of the American Journal of
Sports Medicine.
Thomas Gill, MD and Samuel Van de Velde, MD, together
with David Wing, MD, Luke Oh, MD, and Guoan Li, PhD,
of the Bioengineering Laboratory Sports Medicine Research
Group, have been awarded the 2009 O’Donoghue Sports Injury
Research Award for their work on knee joint kinematics following
reconstruction of the posterior cruciate ligament. The
O’Donoghue award, the most prestigious decoration in sports
medicine, is granted by The American Orthopaedic Society
for Sports Medicine to the best overall paper that deals with
clinical based research or human in-vivo research. In their
paper "Tibiofemoral and Patellofemoral Kinematics Following
Reconstruction of an Isolated Posterior Cruciate Ligament
Injury: In Vivo Analysis During Physiologic Loading", Dr. Gill et
al. have provided an insight in the efficiency -or lack thereof- of
the contemporary single-bundle PCL reconstruction technique
to reproduce normal in vivo knee kinematics.
Over the past year, the in-vivo human spine research at
the Bioengineering Laboratory, in close collaboration with
Drs. Kirkham Wood and Brian Grottkau, has developed considerably.
The Spine Research Group is now quantifying the
biomechanical mechanisms of intervertebral disc deformation
in normal and lower back pain patients during daily activities.
The Laboratory continues their analysis of the effect of current
spinal fusion, disc replacement, and scoliosis fixation on disc
degeneration in adjacent vertebral levels. The spine group has
recently published and submitted a series articles in Spine,
Journal of Biomechanics, European Spine Journal, and presented
in various spine conferences.
The lab has an increasing contingent of outstanding
graduate students from MIT, including Daniel Massimini, Ali
Hosseini, Shaobai Wang, and Kartik Varadarajan, and postdoctoral
fellows, including Drs. Samuel Van de Velde, Peter Passias,
Gang Li, Michal Kozanek, Qun Xia, Fan Liu, Jong Keun Seon,
Bing Yue and Jia Lin Wu. Dr. Kozanek and Liu have been studying
in-vivo OA ankle joint kinematics in collaboration with Dr.
Richard de Asla and investigating in-vivo human gait in collaboration
with Drs. Rubash and Gill. Mr. Massimini continues
to conduct research on in-vivo human shoulder biomechanics
in collaboration with Dr. JP Warner and work towards his PhD
degree thesis. Mr. Hosseini, together with Dr. Wu, continues
to investigate in-vivo ACL forces using advanced imaging and
robotic technology in collaboration with Dr. Thomas Gill. Drs.
Xia, Li and Passias are actively studying intrinsic biomechanics
of human lumbar spine in collaboration with Drs. Kirkham
Wood and Brian Grottkau. Mr. Varadarajan, Dr. Seon and Dr. Yue
made enormous progress in the development of an innovative
reverse engineering method for new TKA component design
and the comparison of Western and Eastern population knee
morphology in collaboration with Drs. Freiberg and Rubash. Dr.
Samuel Van de Velde, is actively publishing on in-vivo ACL and
PCL biomechanics. Dr. Fu has successfully completed a first
in-vivo human forearm kinematics study using the imaging
technique. Hemanth Reddy Gadikota is our core bioengineer
and has actively participated in a variety of clinical and robotic
projects. Mr. Gadikota, Drs. Seon and Wu have successfully
conducted a series of biomechanical testing of various ACL
reconstruction techniques using the robotic system.
The team had over 30 talks, podium presentations, and
posters at this year’s ORS/AAOS. They published in various
peer review journals in arthroplasty, sports, spine as well as
bioengineering fields. The lab also celebrated a new 5 year NIH
supported R01 project for the investigation of ACL reconstruction
biomechanics.
The Harris Orthopaedic Biom echanics and Biom aterials
Laboratory (H-OBBL )
The Harris Orthopaedic Biomechanics and Biomaterials
Laboratory (H-OBBL) is under the co-direction of Orhun
Muratoglu, PhD, and Henrik Malchau, MD, PhD. Members
of this laboratory have contributed to the field of Adult
Reconstructive Surgery for over four decades. A variety of different
topics have been studied and major contributions have
been made particularly in the area of implant stability, implant
fixation, bearing-surface applications, and 1st , 2nd and now
3rd generation of highly crosslinked polyethylenes. Currently,
there are a number of outstanding clinical projects underway
at the H-OBBL. Dr. Charles Bragdon is leading a staff to study
the clinical performance of first generation highly cross-linked
polyethylene and the newly FDA approved vitamin-E doped
polyethylene for use in hip and knee arthroplasties. Dr. Bragdon
has been in the laboratory for over two decades. Charlie and I
did the first canine hip replacement in the mid-eighties!
An additional clinical outcomes study in its 7th year
utilizes RSA techniques to determine the wear behavior of
crosslinked polyethylene in conjunction with the traditional
as well as large heads. This study has shown marked reduction
in wear and femoral head penetration at the 7th year
benchmarks. Dr. Malchau and co-investigators are quite pleased
with these results and state, "So far the first generation highly
crosslinked polyethylene performs as predicted in the preclinical
experiments and seems to be the bearing of choice in the
active patient."
The H-OBBL is also focusing on materials including crosslinked
polyethylene with low-wear and high strength for applications
in hip, knee and other joint arthroplasties. This section
of the H-OBBL is under the direction of the Orhun Muratoglu,
PhD, an innovator in this field for over a decade. The newest
technology utilizes Vitamin E to stabilize the residual free
radicals and to protect the base polymer against oxidation in
the second generation polyethylene. FDA cleared the use of this
material in total hips in 2007 and for total knees in 2008. Ebru
Oral, PhD, and a group of scientists along with Dr. Muratoglu
are leading this important area of investigation.
A new exciting innovation is also in the area of load bearing
materials for use in total joint reconstruction. This new technology
limits the crosslinking of the polyethylene to the articular
surface layer, where it is needed to improve wear resistance.
This method minimizes the loss of mechanical properties. The
investigators at H-OBBL think that this new technology will be
suitable for younger and more active patients.
New exciting areas of collaboration include the area of
knee wear. Drs. Orhun Muratoglu, Henrik Malchau, Dr. Rubash,
Guoan Li, as well as Lars Weidenhielm, MD, PhD, and Eva
Weidenhielm- Broström, PhD, scientists who joined us from
Sweden in early September will be tackling the difficult and
perplexing problem of knee wear. This project will provide
some exciting information with the ultimate goal of detecting
in-vivo wear as it relates to implant longevity. Dr. Li states, "The
innovative dual fluoroscopic technique in a combined effort
with H-OBBL, is being developed to detect in-vivo poly wear to
predict longevity of patients after TKA."
Another new area of collaboration for HOBBL is in the
area of spine kinematics and spine reconstruction. The team is
working on technology using hydrogels as materials for intervetebral
disc replacement along with biodegradable polymer
technology. These studies could benefit many of our patients
with degenerative axial-skeleton disease as well as spinal
deformity. Dr. Kirkham Wood states, "Ongoing studies in the
Biomechanics Lab include projects studying the three-dimensional
analysis of intervertebral disc motion using a combined
MRI-fluoroscopic technique; the effects of disc degeneration
on in-vivo disc deformation and the effect of spinal deformity
surgery on adjacent segment vertebral kinematics using noninvasive
techniques."
The H-OBBL is a source of enormous activity and energy
in the area of translational and basic science research. The skillful
scientists in this laboratory had another incredible year at
the ORS and the AAOS with over 20 abstracts presented. Once
again the members of this outstanding laboratory have added a
tremendous amount of new knowledge to our field. I know that
these important contributions will continue in the future.
Laboratory of Musculoskeletal Engineering
The Laboratory for Musculoskeletal Tissue Engineering,
under the direction of Mark Randolph and Dr. Thomas Gill,
focuses on cartilage repair and regeneration in the knee.
The group focuses on developing new hydrogels for articular
cartilage repair and regeneration. Working with Drs. Robert
Redmond and Irene Kochevar from the Wellman Center of
Photomedicine, they have developed a novel means to photocrosslink
collagen gel for use as an encapsulation gel for
chondrocytes and neocartilage formation. Initial work on cell
survival following photopolymerization was published in Tissue
Engineering in 2007 (Ibusuki S et al, 13(8):1995-2001). Follow
up studies on the capacity of these photopolymerized collagen
gels to form neocartilage was published in the Journal of Knee
Surgery in January 2009 (Ibusuki S et al 22(1):72-81). A
grant from the AO Foundation to continue this work has been
received by Dr. Redmond where the work will focus on improving
the biomechanics of the gel and improving cell survival.
Parallel work on the cartilage formation capacity of human
articular chondrocytes placed in hydrogels has been funded by
a grant to Dr. Gill from the NFL Charities. The collaboration
will also include Dr. Seemantini Nadkarni from the Wellman
Center for Photomedicine who will focus on using laser speckle
imaging as a noninvasive means for measuring the modulus of
native and engineered cartilage.
New studies in collaboration with Dr. Orhun Muratoglu in
the Department’s Orthopedic Biomechanic and Biomaterials
Laboratory are exploring a hybrid scaffold composed of nondegradable
poly (vinyl alcohol) scaffold combined with chondrocytes
for joint cartilage replacement. Several types of PVA
hydrogels have been tested for cell compatibility and cartilage
formation in mice with support through and Academic
Enrichment Fund grant from the Department of Orthopedic
Surgery. Progress to date has identified several candidate gels
that support new cartilage formation and pilot studies are
underway testing these gels in joint surface repair in swine.
Previous work funded by the AO Foundation focused on
tissue engineering strategies to repair lesions in the avascular
regions of the meniscus. The results demonstrated an efficient
means to seed chondrocytes onto polygalactin (PLGA) scaffolds,
and the capacity of this cell-scaffold constructs to heal
bucket handle lesions made in swine menisci. One study published
in the American Journal of Sports Medicine in November
2006 (Weinand C, et al, 2006, 11:34) presented preliminary
data on using allogeneic chondrocytes for meniscal repair. A
recent grant from the Musculoskeletal Transplant Foundation
will allow us to test the utility of allogeneic chondrocytes for
healing lesions in the swine meniscus.
Sarcom a and Molecular Biology Laboratory
The Sarcoma Molecular Biology Laboratory (SMBL), under
the direction of Zhenfeng Duan, MD, PhD and Francis J.
Hornicek, MD, PhD, is working on understand the mechanisms
of multidrug resistance, identification of small molecules and
targets to reverse drug resistance, and characterization of
molecular mechanisms governing growth, proliferation of
human sarcoma cells.
The overall objectives of our laboratory are to explore
biological mechanisms of tumors arising in bone and other
tissues. One of the major focuses of the lab is to elucidate the
mechanisms of the development of drug resistance in cancer.
Previously, we have found multidrug resistance could be partially
reversed by siRNA targeting of ABCB1 (MDR1) or by combination
of nanoparticles with chemotherapy drug. Recently,
we have identified two small molecules that can overcome drug
resistance in vitro. Another significant aim of our research is to
define the essential kinases that are responsible for proliferation
and survival of human sarcoma cells. In addition, translational
research into new treatment options for sarcoma patients has
been undertaken. Continued collaboration with other institutions
and pharmaceutical companies has provided the foundation
for evaluation of new drug development. Many of these
drugs are derived from marine sources and their corresponding
biochemical structures are quite complex. The Sarcoma
Molecular Biology Laboratory has published articles pertaining
to multiple drug resistance in human cancer. Research projects
on sarcoma biology have received funding from a variety of
sources including NIH, foundations, corporate sponsors, and
benefactors.
The sarcoma research group at the MGH includes investigators
from multiple disciplines, as does the clinical group. We
hope to continue research expansion and further collaboration
within the Harvard community.
LABORATORY UPDATES AND RENOVATIONS
It has been a busy and productive year for the Orthopaedic
Research Laboratories. During the past year extensive renovation
has been performed within the Bioengineering Laboratory
site on Jackson 12. In addition a central area on Jackson 11 has
been renovated and one of the older walk-in cold rooms has been
removed. With the modifications to the space we have been
able to create a new PI office, several workstations for students
and also a central facility for minus 80 degrees freezers. The
space regained by this renovation will be shared between the
Orthopedic Research laboratories on Jackson 11 and 12. I am
pleased to report that the new Shoulder Laboratory under the
direction of Dr. J. P. Warner opened at Jackson 12 earlier this year.
DEPARTMENT HOLIDAY PARTY
This year’s annual black tie Department Holiday Party
was held at was held at the lovely Seaport Hotel in South
Boston. There were nearly 400 delighted revelers in attendance.
Everyone enjoyed the festive music, holiday-themed
decor, and of course the sumptuous food. Plans are underway
for next year’s exciting event.
PERSONAL NOTE
It is a great pleasure to update everyone on what is happening
in my own personal life. During this past year, Kim and
I celebrated our thirtieth wedding anniversary and unfortunately
due to a family issue we were unable to travel to Tuscany to
do our bike tour. We have rescheduled for the fall and hopefully
in my next year’s report I will be able to share some spectacular
pictures from our trip.
My oldest son Brad is graduating
from Rollins College in Florida this
year. Recently he called me and said,
“Dad, I’ve decided on my Internship
for the summer…” I asked him where
he was planning to go and he replied,
“Quantico, Virginia.” My next response
was, “Brad isn’t that where the Marines
train?” He replied, “Yes, Dad, I’m planning
to join the Marines and enter the
Officers Candidate School in Quantico.”
My next response was, “Have you told your mother?” Kim and I
are most proud of our son’s decision and will support him fully.
He would like to become a Marine Pilot and will be the entering
the program in June 2009. Best wishes, Brad!
Steven is in his junior year at Boston University (BU) and
is fascinated and fully engaged in the Management Program.
He needed to take some time off last fall and he is glad to be
back in his classes. My wife and I and Steven had the opportunity
to spend more time together over the winter and spring of
this year. We are hopeful that Steven will continue to perform
in an outstanding fashion at BU. He is an immensely talented
young man and we wish him well.
Kristin has transferred from Wheaton College to Rollins
College in Florida. She has decided to spend her fall and winter
term with her horse in Florida so that she can continue pursuing
her academic studies along with her riding career. She
has decided to enter the International Business Program at
Rollins with a minor in Psychology. We are most proud of her
decision. Her shoulder has recovered from her recent fracture
(thank you Dr. Tom Holovacs) and she is back riding and going
strong. She plans to spend the summer in Canada training in
Equestrian Eventing.
Once again it is a great pleasure and an honor to continue
to work with all of you in this wonderful department at this fine
institution. I wish all of you the best of success and my door is always open!!
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